Respiratory Support for COVID-19

In this lesson we take a look at the progression of respiratory support that we want to provide to our patients with COVID-19. While the ideal treatment strategy is not fully known, we have months of data and experiences from China, Europe, here in the US and around the world to draw on and we have identified strategies that seem to work and help our patients.
Covered in this lesson are low flow nasal cannula, high flow nasal cannula, CPAP and BiPAP, awake prone position, invasive mechanical ventilation, prone ventilation, and VV-ECMO. This lesson serves as a quick overview of each of these as well as covering the overall guiding schema towards the progression through these various treatment options.
0:00 Intro
2:59 Low Flow Nasal Cannula
4:53 High Flow Nasal Cannula
8:05 CPAP
10:18 Awake Prone Positioning
11:47 Invasive Mechanical Ventilation
15:01 Prone Ventilation & ECMO
16:47 Conclusion
👁 CHECK OUT these adorable virus plush toys!
🦠 GIANTmicrobes Plague Inc: Nano-Virus - amzn.to/2U4ILRW
🦠 GIANTmicrobes Plague Inc: Bio-Weapon - amzn.to/2U5EJZi
🙏🙏 A Special THANK YOU to Patreon Members!!! 🙏🙏
🥇Trauma Team: Carlos Lopez and Donald Crawley
🥈Rapid Response Team: Quetina Quartey and Stephanie Morency
🤔Curious how you can show your support?
I recently started a Patreon page to provide extra content and incentives to our amazing fans! I promise to use any support you provide in order to help to make even better videos for this channel, while giving you guys extra perks over there that you wouldn't normally get just here on KZbin.
If you are interested in supporting ICU Advantage on Patreon head over to: / icuadvantage
If not, no worries, as you watching videos here, liking them, commenting and sharing them also really help to support the channel! 😍
📚📖BOOKS I RECOMMEND
✔️Barron’s CCRN Exam: amzn.to/2MFWIkH
✔️Pass CCRN!: amzn.to/36apxgN
✔️AACN Essentials of Critical Care Nursing: amzn.to/2F5riQs
✔️Kaplan Adult CCRN Review: amzn.to/37igv1t
✔️Marino’s The ICU Book: amzn.to/2ZzKP4Y
🩺🏥🖊SOME OF MY FAVORITE NURSING GEAR
✔️3M Littmann Master Cardiology Stethoscope: amzn.to/2sn0wR5
✔️Rip Shears - Trauma Shears: amzn.to/35diZwR
✔️Leatherman - Raptor Shears: amzn.to/2MGF801
✔️Stethoscope Tape Holder: amzn.to/2snWkAy
✔️Pilot FriXion Erasable Pens: amzn.to/2Qw9pQg
💻🎙GEAR THAT I USE TO MAKE THESE VIDEOS
✔️Apple Pencil: amzn.to/368qS83
✔️iPad Pro 12.9”: amzn.to/367s2QV
✔️Blue Yeti Mic: amzn.to/2Q7vrK9
✔️MacBook Pro 15”: amzn.to/2tcDegM
👍🏼👍🏼👍🏼
If you enjoyed this video or found it useful, please hit the like button as this greatly helps our channel out! Also make sure and subscribe and hit the bell icon and select all notifications to stay up to date on our latest videos!
👁🎥👁🎥
Check out these other great lessons and series of lessons below!
✅ Hemodynamics Principals: • Hemodynamic Principals
✅ Shock: • Shock
✅ ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
✅ ICU Drips: • ICU Drips
⚠️⚠️ DISCLAIMER: Links included in this description are affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you!
❗️❗️PLEASE NOTE: ICU Advantage medical videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider.

[@sinahaase9923]

My mom, 64, is currently in the ICU on the bipap. When it’s feeding time, she switches to hi-flow. We (my family) are very hopeful and optimistic and my mom also is very determined to beat this. Her dr however is so into giving up which I can understand too cuz she’s used to seeing her patients pass away but it’s so frustrating to communicate with her. She is done with all medication like remdesivir, some anxiety medication and is just taking some aspirin for a small stroke she had too during her stay plus a steroid. She’s hanging in there in the middle to high 90’s and we’re just hoping she can recover. They let me suit up today and actually see her for an hour and I’m serious her oxygen level went up when she saw me. After I left they fed her and of course her oxygen went down but went back up after the bipap was replaced BUT is only at 90-92. It’s crazy. I hope she pulls thru. If you have a moment, please pray for my mom. Her name is Sandarina and I want her to live 🙏🏽🙏🏽🙏🏽 thank you!

[@Jacob_What]

Hi, we are in the same situation with my father Inlaw. How is your mom doing? We will be praying for her also.

[@sinahaase9923]

Update: my mom passed away on Monday 😭 I have no words just sounds that express this pain. She was my best friend…my ONLY friend. I am so sad.

[@sinahaase9923]

@@Jacob_What I think we posted around the same time. Unfortunately she didn’t make it…the pain in her chest from her lung deterioration was unbearable. She asked for comfort care and we couldn’t say anything to change her mind it was just too insufferable! So crazy 💔💔💔😭😭😭😭 I hope u don’t go thru this it’s just crazy

[@sinahaase9923]

@@Jacob_What let me know how it goes 🙏🏽🙏🏽🙏🏽 I’m sorry u have to be in this situation but I believe there is hope! I did with my mom and I don’t regret the hopefulness God be with u

[@mermaid_32]

Thank you soooo much. My grandmother is in the icu on a high flow cannula and I’m trying to learn as much as I can so I could have a more clear understanding when I speak to doctors/nurses. May you be blessed

[@ICUAdvantage]

Wishing your grandmother all the best in her recovery! Take care.

[@aljox5566]

Hey how is your grandma??

[@virgiliosilva5010]

Thank you eddie for this video. Your video are very helpful to keep our learning up to date for us working in small community hospitals. Your channel is my best discovery this year. Thanks again form ON, Canada 🍁

[@ICUAdvantage]

Thank you so much Virgilo! This is such an awesome comment and so great to hear the far reaching impact of this information. So glad you found the channel.

[@nargizsafarova9989]

Thank you very much for your clear explanation. I got lots of new information from your lecture.

[@ICUAdvantage]

Fantastic!! You're very welcome.

[@sarahk7498]

So helpful! I am a new grad RN starting on a COVID floor and was feeling lost in understanding the progression/indications for each level. Thank you! :)

[@ICUAdvantage]

You're very welcome Sarah! 😊 I'm glad to hear I was able to help shed some light on some of the progression. Sorry to hear this is how you are starting off your nursing journey, but hopefully we will eventually get past all this.

[@NiniJoseph]

Thank you. You're videos helped me out a lot with work.

[@ICUAdvantage]

You are so welcome!

[@RN1BSN]

Another amazing video! Thank you 😊

[@ICUAdvantage]

Thank you so much! I really appreciate you!

[@antoninafirsova9248]

Thank you very much for your good explanation👍.

[@ICUAdvantage]

Glad you liked it!

[@inesbecirevic9502]

Thank you for this video it helps me understand the oxygen procedures a little better as my dad is fighting this nightmare right now.

[@jaircastaneda9412]

how is he now?

[@jaircastaneda9412]

Hang on there bro!!

[@manjushreeinamdar1242]

Thankyou so much for teaching us all this. I hope you stay healthy and safe. You're awesome. Also the recommendation for the books ar reallyyyy helpful.

[@ICUAdvantage]

You are more than welcome. Glad to be able to spread the knowledge and help others. You stay safe and health as well!

[@carnuroalnanda5241]

Nice Video clip! Apologies for the intrusion, I would appreciate your initial thoughts. Have you heard about - Franaar Magic Dream Formula (Have a quick look on google cant remember the place now)? It is a smashing one of a kind guide for eradicating sleep apnea and snoring minus the headache. Ive heard some super things about it and my cooworker got excellent results with it.

[@alirezaabdi2234]

Very excellent, thank you

[@ICUAdvantage]

Thank you too!

[@AlienAngel543]

Thank you very much bro. Really helpful.

[@ICUAdvantage]

Glad to hear that

[@agewelluganda9087]

Thx for such educative info

[@ICUAdvantage]

Glad it was helpful!

[@kamaljauoda9633]

Thank you

[@ICUAdvantage]

You're welcome

[@nezarrifat6649]

very good presentation. Thanks

[@ICUAdvantage]

Glad it was helpful!

[@motasemibrahim2227]

Thx ..you doing great job and i am following you when corona started...i am consult GS..volunteered to work in ICU...and really need thing to be just ecplained in simple way.. Thx again

[@ICUAdvantage]

It's my pleasure! Glad you have enjoyed these videos!

[@gemmacarter6103]

Thank you so much for this information. I just admitted my dad to the Hospital with breathing problems die to covid and this clarify so many things that I couldn't understand.

[@ICUAdvantage]

Hoping for a speedy recovery for your dad!

[@aprilapril2]

Hope he gets well soon

[@greensahuaro2834]

thanks you! I am a respiratory therapist and having covid patients. I feel they need more humidity with high oxygen content with NRM or a BIPAP. I don't experience it on the floor at a rehab subacute hospital. The lungs membrane needs to be wet. 100% oxygen content on a NRM or a BIPAP is dey and the dryness with 100% can cause oxygen toxicity and that makes covid lungs more stiff and worse. We should also implement demand flow and pressure, it will be more tolerable than continuous flow and will decrease work of breathing. More like Non Invasive ventilation with pressure and humidity. Also to use normal saline instead if water, it better for the membrane. Before covid the last flus causes dry coughs, I gave normal saline treatments occasionally to co workers and to my self and my coughs hot better. It will also help atelectasis. So more humidity, demand pressure breaths to decrease work if breathing and to improve oxygenation.

[@ShailjaTrivedi]

Wonderful video😃

[@ICUAdvantage]

Thank you 🤗

[@dirgsuite5546]

which method is most used in hospitals on the whole? Which for (non-ICU)for moderate covid cases? which for severe (ICU)cases? Is it used at all for critical cases?

[@jordanandkimbothepugs]

Thank you, my father is a smoker, has pneumonia and was admitted on HFNC and moved to Low flow. I’m trying to understand what’s going on to him and why he’s moved..

[@dawoodazeemy5261]

Really helping me in my practice. Can you make a video on sedation of intubated COVID-19 patients?

[@davidmamdouh2450]

Yes..that would really help alot

[@ICUAdvantage]

Great suggestion. I'll add that to the todo list here soon. Thank you and glad you are enjoying the videos.

[@chanaleh4]

Yes, that would be very helpful!

[@patvaughn9987]

Just a quick question about your liter flow range stated on your high flow nasal cannula. It is my understanding that the device runs up to only 40 lpm not the 50-60 lpm as you stated. Perhaps this is a device other than the Vapotherm brand I am familiar with. Nice information presented.

[@ICUAdvantage]

Hi, great question! So, at the time this video was made, we hadn't really used the Vapotherm. The high flow that we utilize has a max of 60LPM. With this pandemic and the need for many more of these devices, we did receive a bunch of Vapotherms and one of the limitations for us with them is their max flow availability of 40LPM. So we tend to use them on those patients requiring less support and switch to our other high flow devices when more is needed.

[@TheChauhanmohit57]

Sir can you please tell us about using high peep in COVID Ards?

[@elizabethmonje3126]

Thank you for putting out videos to educators when covid hit home my son and me were not ready we did practice prevention but we're always working so really didn't know what to do when the virus hit he got nervous went too Banner hospital emergency room in Glendale Arizona he was just a few days away from being over free Banner told him he had pneumonia cave imprintness on in antibiotics by the third day of taking the meds had to call 911 hospitalized and intubated and died I was shocked what happened I went to the hospital information portal to fine answers and that's where I saw that he had been given around diagnosis because they failed to see the small details all they saw was covering it automatically said in the morning and send them off to his death but the report says he was 40 years old no underlying conditions was breathing good vitals were all good the doctor checks his lung set the lungs were clear the one that did the X-ray say said that they were unsure yet the last doctor without looking at the details said covid pneumonia and send it to his death if she would have looked at the details she would have seen that he was a recovering covid patient but she saw was the residual effects of covid and he would be alive today if she would have sent him home with covid information follow up with the doctor since he was so close to being covid free instead she killed him now lawyers won't touch these covert cases and all I can do is want people do you research if you have to go to the hospital make sure it's a good hospital I'm not saying all the hospitals are bad but Banner here in Glendale is so take care and be careful

[@Madmaxxxx1984]

The antibiotics made it worse ??

[@kristinaldridge1712]

This is great that you explained each stage but you didn't explain when and why. For example how low does the oxygen saturation have to be to decide which method to use?

[@ICUAdvantage]

Thanks for the feedback. So the problem is that there isn't a one size fits all answer. The big determining factor is going to be our patients work of breathing and their condition. We can see and tolerate much lower oxygen saturation with COVID. The happy hypoxic phenomenon. We don't want to make determinations solely on our sats. I wish I had a better answer but our goal in progression of support is focus a lot on their respiratory effort and work of breathing vs just what their sat is alone. Trends in saturation will probably tell us more, or abrupt acute changes along with increase WOB. Hope that makes sense.

[@AlawiKD999]

thanks for this Q: why do we wait for patient almost crushing before intubation? isn't early intubation better for ARDS patients?

[@ICUAdvantage]

We found poor outcomes with COVID once ventilated, thus would try and manage without intubation when possible.

[@titocruz2467]

Thank you for all that information. My kids mom has COVID-19. She’s been on a ventilator for three weeks. My daughters are very worried for there mom. What do think of her making it out ICU successfully?

[@ICUAdvantage]

I'm really sorry to hear she is going through this. Unfortunately theres no where I'd be able to answer that question. I truly would direct that to the team that is caring for them as they will have a much better idea of what is going on. Hoping for the best for her.

[@GLO1951]

My mom is on high flow 40 at 100 percent I am so confused and don’t really understand all this she’s been in the hospital for 9 days already since she’s stable not getting worse or better they started her on physical therapy yesterday 🙏 that God heals her 🫁 she’s so sad being in the hospital with covid alone I’m able to see her for around 15 minutes sometimes I stay more but I also have my dad who is also sick and can’t walk and I have to take care of him and also work it’s 😢

[@davidmamdouh2450]

Why not venturi mask or non rebreathing mask are used?

[@ICUAdvantage]

Those are certainly viable options, but if HFNC and BiPAP are available, I feel those offer more adjustable, and in some ways, better support for the patient.

[@ryanfarkas106]

Nice, learned a bunch of new stuff. One challenge I've noticed, all of our vented covid pts seem to go through some kind of hypotensive crisis by the time of/or at the time of intubation. Usually results in AKI requiring CRRT (also for academia correction), which constitute a hard contraindication to proning. Maybe letting them run in the 80s is too low? stresses their hearts and organs? That is if they even tolerate any kind of movement (de-recruitment and low BP issues). Any thoughts about this?

[@ICUAdvantage]

Hmm interesting that your seeing so much shock state. Typically I've seen they haven't presented as shocky as normally seen with typical Sepsis/ARDS. You said you are seeing it before intubation, or is it after? Are they responding to pressors and if so, are they high doses? AKI and CRRT certainly isn't uncommon with these patients. We had a lot of CRRT especially early on. Are you saying that then is a contraindication for proning, as we will still prone. Do you feel like you guys are intubating late, trying to avoid it at all cost? I do agree that sometimes they just are not stable to prone, but from a pulmonary standpoint, theres a pretty high likelihood that you'd see improvement from being supine. BP can be an issue though with proving, but if they aren't crumping and pressor responsive, that could help.

[@ryanfarkas106]

@@ICUAdvantage They are responsive to pressors, though I do wonder of we inubate too late. Survival rate of intubated covid pts is dismal, so yeah, we are trying to avoid with aggressive awake proning. But they seem to just go through the course no matter what. At least those who make it to ICU. I am surprised you prone with CRRT tough. yes, I see shock usually with or right after intubation

[@robnation2475]

add vitamin D and Zinc NOW to avoid the ICU later. Eat well, sleep more. Avoid foods that trigger asthma/allergies/sensitivities etc. Avoid Thanksgiving dinner ...particularly relatives with weird food and cats/dogs/birds.

[@mohdtoufique7446]

How many days it will generally take for the patients who have low oxygen in blood to become normal value of around 95..?

[@ICUAdvantage]

Far too many factors to be able to answer a question like this unfortunately.

[@mohdtoufique7446]

Actually if the patient has pain on right side of chest if he is walking or facing breathlessness when walking as per your 6 minute test what could be the problem.. he has been already tested negative on22 nd august after coming positive on 10th august..

[@bhavanabhanuvlogs8787]

@mohd- any update on how many days after covid test negative, oxygen therapy was continued? Thank u

[@xhmuneeb1774]

Hello sir my father is in icu.His saturation is 98% on 15 litre on nrm. But whenever we lower it he start getting uncomfortable.Doctors suggest to use cpap.What do u suugest?I think its a risk

[@MohitSinha4]

Hey, How is your father now? Was he on cpap?

[@motasemibrahim2227]

Can you start vedio from step one of simple covid 19 then escalate up to ECmo. With indication for each step and pitfall or thing should be avoided.. Thx 👌💯

[@ICUAdvantage]

Thanks for the suggestion

[@jayashree1084]

Patient given mechanical ventilation when oxygen falls to 60 and in sedative on 13th day from initial symptom. Age 40M, no other issues in kidney, liver etc , only lung infection. O2 is 90-95 after start of mechanical ventilation.Please kindly tell me if there is chance of recovery.

[@aljox5566]

He might take some longer time. On ventilation is a doubt. But we can hope for the best.

[@aljox5566]

If the O2 doesn't fall from 90, then yes chance of recovery is good

[@jayashree1084]

@@aljox5566 Thanks for response. Please include him in your prayers

[@darrelljones3382]

@@jayashree1084 Did the patient recover? 🙏🙏

[@debranelson123]

I was really surprised to see you recommend BiPAP for Covid+ patients. It’s very dangerous for the staff and so far it has only delayed intubation. By the time they look like they need NIV they really need to be on a vent.

[@ICUAdvantage]

Not necessarily. It is aerosolizing, but with proper protection can be used safely for staff. The highest exposure risk comes from intubation. If we use these respiratory support therapies in the ways we have in the past, I can see where you would feel they need a vent at that point. The purpose is to use them proactively to try and provide support and prevent them from reaching the point of intubation.

[@ICUAdvantage]

Clinical judgement is still key and making a decision to intubate is not black or white either, but we have had much success with CPAP and BiPAP.

[@chanaleh4]

NIV carries less LT risk than a vent, they can always be put on a vent if NIV fails....it's something to consider case by case of course.

[@johnmink2324]

Anyone else doing the nc+nrb?

[@ICUAdvantage]

I have heard of this, but we are not. What's your experience with it?

[@lianata9555]

We use HF and nbr mask together with success on some patients at my unit.

[@kenethsaulsberry6735]

Hi my dad is currently staying at 94 on 30liters of o2 is this bad?

[@kevinkev9996]

Im currently at 95-96 on 14 liters I can't stand up without gasping for air

[@kenethsaulsberry6735]

@@kevinkev9996 hang in there bro my dad just got discharged today

[@kevinkev9996]

@@kenethsaulsberry6735 I'm on 10 now and I'll probably be home in 2 days I'm glad to hear about your father

[@kenethsaulsberry6735]

@@kevinkev9996 I’m so happy for you i both are warriors

[@kellyprofitt5123]

@@kenethsaulsberry6735 my dad is in the hospital now on 15 lpm.. The nurse said it can be a very long road. My dad has never been sick. Always healthy..it's been veru scary 🥲

[@Asbss]

CPAP or bipap which has more clinical benefits in covid 19

[@debranelson123]

We have found that BiPAP only delays much needed intubation and a vent.

[@ICUAdvantage]

We don't use straight CPAP much. I wish we had access to the CPAP hoods. It seems like the CPAP (EPAP in BiPAP) support is more what most need. Truly seeing good success with HFNC though.

[@47harsha31]

Patients cough at rate of 400l/min

[@babycat8580]

The happy venezuela elderly educate because pilot concordantly pat into a rural minister. jealous, marked lier